NR 507 Week 6 Assignment; Case Study – Suspected Diabetes Essay
NR 507 Week 6 Assignment; Case Study – Suspected Diabetes Essay
NR 507 Week 6 Assignment; Case Study – Suspected Diabetes Essay
Week 6 Case Study: J. T.
1.Review the lab findings and decide if the diagnosis is Type 2 or Type 1 Diabetes Mellitus.
Diabetes is a metabolic disorder characterized by abnormally high blood glucose levels. Insufficient insulin synthesis or insulin resistance contributes to this elevated blood glucose level. Type 2 diabetes is influenced by being overweight, having an unhealthy diet, not getting enough exercise, being under a lot of stress, and old age. J. T most likely has Type 2 Diabetes Mellitus, according to the test results and his medical history. Type 2 diabetes is commonly diagnosed using glycated hemoglobin (A1C) test. A person with type 2 diabetes usually has blood sugar levels of 200 mg/dl or higher on a random blood sugar test, 200 mg/dl on an oral glucose tolerance test, and 126 mg/dl or higher on a fasting blood sugar test. Mr. J.T. has FBS testing of 132 mg/dL, AIC of 7.2%, and oral glucose tolerance of 220mg/dL, all indicative of Type-2 diabetes.
ORDER A CUSTOM PAPER NOW
- Explain the pathophysiology associated with your chosen diagnosis
Type 2 diabetes is a chronic metabolic condition that leads to hyperglycemia (high blood sugar levels) caused by insulin resistance and decreased insulin production. The mechanism of type 2 diabetes involves an intricate combination of genetic, environmental, and dietary factors that fail multiple organs, such as the liver, muscles, liver and adipose tissue (La Fontaine & Crisologo, 2020). Type 2 diabetes causes insulin resistance, in which cells become less sensitive to insulin, and glucose absorption decreases while glucose synthesis in the liver rises (La Fontaine & Crisologo, 2020). This results in hyperglycemia, which, in turn, leads to inflammation, oxidative stress, and vascular and neuronal damage. Damage to tissues and diabetic complications are caused by advanced glycation end products (AGEs), which are accelerated by chronic hyperglycemia.
Insulin resistance is a significant factor in developing type 2 diabetes, while decreased insulin production by pancreatic beta cells is also a contributing factor. Possible causes include hereditary factors, dysfunctional beta cells, and reduced incretin function (La Fontaine & Crisologo, 2020). Incretins are hormones that cause an increase in insulin production in response to eating, and they may influence the development of type 2 diabetes if they become dysfunctional.
Type 2 diabetes is also strongly linked to obesity and adipose tissue dysfunction. Adipokines are inflammatory proteins and insulin regulators that are secreted by adipose tissue. Insulin resistance is caused by the pro-inflammatory adipokines released due to obesity (La Fontaine & Crisologo, 2020). Lifestyle variables, including physical inactivity and poor food preferences, influence the pathophysiology of type 2 diabetes. Diets high in saturated fat and refined carbohydrates may promote beta-cell dysfunction and decreased glucose tolerance. In contrast, a lack of exercise and a high-calorie diet encourage weight gain and insulin resistance.
- Identify at least three subjective findings from the case which support the chosen diagnosis.
The patient complains of increased thirst, weight loss, and experiencing fatigue.
- Identify at least three objective findings from the case which support the chosen diagnosis.
He has a BMI of 36.5, an A1C of 7.2, and fasting blood sugar of 132.
Identify two (2) “Evidence A” recommended medication classes for the treatment of this condition and provide an example (drug name) for each.
The American Diabetes Association recommends using biguanides and Glucagon-like peptide-1 (GLP-1) receptor agonists. An example of biguanides is metformin, while GLP-1 receptor agonist is exenatide.
- Describe the mechanism of action for each of the medication classes identified above.
Biguanides
Biguanides reduce glucose production by the liver, boosts insulin sensitivity and enhance muscle glucose uptake. They reduce the circulating glucose by inhibiting gluconeogenesis. The activation of AMP-activated protein kinase (AMPK) is likely responsible for this action, as it reduces glucose synthesis in liver cells. Biguanides improve peripheral tissue insulin sensitivity, allowing greater glucose uptake from the bloodstream by tissues. This impact is believed to be mediated by AMPK activation, which promotes glucose absorption by increasing the translocation of glucose transporters to the cell surface. In addition to reducing glucose levels, biguanides have been demonstrated to affect the gut flora and the immune system positively. They have been shown to influence energy metabolism and insulin sensitivity, which may be due to the effects on the gut flora.
Glucagon-like peptide-1 (GLP-1) receptor agonists
GLP-1 receptor agonists mimic the effects of GLP-1, a hormone the body produces following eating. GLP-1 aids in regulating blood sugars by increasing insulin production while decreasing stomach emptying and glucagon secretion (Müller et al., 2019). GLP-1 receptor agonists adhere to and stimulate the GLP-1 receptor on pancreatic beta cells when the levels of glucose rise, causing the beta cells to secrete more insulin. To further lower glucose production by the liver, they inhibit glucagon secretion from pancreatic alpha cells.
Gastric emptying is slowed by GLP-1 receptor agonists, which, along with their actions on pancreatic function, can aid in minimizing postprandial blood glucose rise (Müller et al., 2019). They make one feel fuller for longer, cutting overall calorie intake and aiding in weight loss. The likelihood of cardiovascular events can be decreased, and kidney function can be enhanced with the help of GLP-1 receptor agonists.
- Identify two (2) “Evidence A” recommended non-pharmacological treatment options for this patient.
The guideline recommends the adoption of good diet habits. Persons living with diabetes are advised to consume a balanced diet that contains fruits, whole grains, healthy fats, and lean proteins (Toi et al., 2020). They should also reduce processed foods, added sugars, and saturated fats. The individuals should collaborate with dieticians to help them develop meal plans that fit their lifestyle while assisting them in meeting their nutritional needs. They should also regulate the uptake of carbohydrates and adjust their insulin doses.
Consistent physical activity has been shown to enhance insulin sensitivity, decrease blood glucose levels, and lessen the likelihood of cardiovascular disease and other diabetes-related problems (Amanat et al., 2020). ADA recommends that persons with diabetes have at least 3 hours of aerobic activity per week, split between at least three days of exercise and two days of rest (Amanat et al., 2020). Fast walking, bicycling, swimming, and dancing are all examples of moderate-intensity activities. Strength training, including weight lifting, is also suggested at least two days per week, in addition to cardiovascular activities (Amanat et al., 2020). Muscle strength and bulk can be increased by resistance exercise, which may improve glucose regulation and general well-being.
ADA advocates taking steps to reduce sedentary behavior, such as prolonged sitting. Maintaining glycemic control can be aided by minimal physical exercise, such as standing or walking. People with diabetes should engage with their healthcare team to design a personalized exercise regimen that accommodates their age, fitness level, and other medical issues they may have (Amanat et al., 2020). To prevent hypoglycemia, it is crucial to monitor blood sugar levels before, during, and after exercise and make the appropriate modifications to medication and diet.
References
Amanat, S., Ghahri, S., Dianatinasab, A., Fararouei, M., & Dianatinasab, M. (2020). Exercise and Type 2 Diabetes. Physical Exercise for Human Health, 1228, 91–105. https://doi.org/10.1007/978-981-15-1792-1_6
Katzung, G., & Kruidering-Hall, M. (2019). Lippincott illustrated reviews: Pharmacology (8th ed.). Wolters Kluwer.
La Fontaine, J., & Crisologo, A. (2020). Diabetes mellitus—Infections and fracture healing. Diabetes Mellitus, 117–135. https://doi.org/10.1016/b978-0-12-820605-8.00006-1
Müller, D., Finan, B., Tang-Christensen, M., Woods, C., DiMarchi, D., & Tschöp, H. (2019). Glucagon-like peptide 1 (GLP-1). Molecular Metabolism, 30, 72–130. https://doi.org/10.1016/j.molmet.2019.09.010
Toi, L., Anothaisintawee, T., Chaikledkaew, U., Briones, R., Reutrakul, S., & Thakkinstian, A. (2020). Preventive role of diet interventions and dietary factors in type 2 diabetes mellitus: An umbrella review. Nutrients, 12(9), 2722. https://doi.org/10.3390/nu12092722
ORDER A PLAGIARISM-FREE PAPER HERE
- Refer to the rubric for grading requirements.
- Utilizing the Week 6 Case Study TemplateLinks to an external site., provide your responses to the case study questions listed below.
- You must use at least one scholarly reference to provide pathophysiology statements. For this class, use of the textbook for pathophysiology statements is acceptable. You may also use an appropriate evidence-based journal.
- You must use the current Clinical Practice Guideline (CPG) for the Standards of Medical Care in Diabetes -Abridged for Primary Care Providers provided by the American Diabetes Association to determine the patient’s type of diabetes and answer the treatment recommendation questions. The most current guideline can be found at the following web address: https://professional.diabetes.org/content-page/practice-guidelines-resourcesLinks to an external site. At the website, locate the current year’s CPG for use.
- Proper APA format (in-text citations, reference page, spelling, English language, and grammar) must be used.
Case Study Scenario
Chief Complaint
J.T. is a 48-year old male who presents to the primary care clinic with fatigue, weight loss, and extreme thirst and increased appetite.
History of Present Illness
J.T. has been in his usual state of health until three weeks ago when he began experiencing symptoms of fatigue, weight loss, and extreme thirst. He reports that he would like to begin a walking program, but he feels too fatigued to walk at any point during the day. Now he is very concerned about gaining more weight since he is eating more. He reports insomnia due to having to get up and urinate greater than 4 times per night.
Past Medical History 
- Hypertension
- Hyperlipidemia
- Obesity
Family History
- Both parents deceased
- Brother: Type 2 diabetes 
Social History
- Denies smoking
- Denies alcohol or recreational drug use
- Landscaper  
Allergies
- No Known Drug Allergies 
Medications
- Lisinopril 20 mg once daily by mouth
- Atorvastatin 20 mg once daily by mouth
- Aspirin 81 mg once daily by mouth
- Multivitamin once daily by mouth
Review of Systems
- Constitutional: – fever, – chills, – weight loss.
- Neurological: denies dizziness or disorientation
- HEENT: Denies nasal congestion, rhinorrhea or sore throat.  
- Chest: (-)Tachypnea. Denies cough.
- Heart: Denies chest pain, chest pressure or palpitations.
- Lymph: Denies lymph node swelling.
General Physical Exam  
- Constitutional: Alert and oriented male in no acute distress   
- Vital Signs: BP-136/80, T-98.6 F, P-78, RR-20
- Wt. 240 lbs., Ht. 5’8″, BMI 36.5
HEENT 
- Eyes: Pupils equal, round and reactive to light and accommodation, normal conjunctiva. 
- Ears: Tympanic membranes intact. 
- Nose: Bilateral nasal turbinates without redness or swelling. Nares patent. 
- Mouth: Oropharynx clear. No mouth lesions. Teeth present and intact; Oral mucous membranes and lips dry. 
Neck/Lymph Nodes 
- Neck supple without JVD. 
- No lymphadenopathy, masses or carotid bruits. 
Lungs 
- Bilateral breath sounds clear throughout lung fields. Breathing quality deep with fruity breath odor
Heart 
- S1 and S2 regular rate and rhythm; – tachycardia; no rubs or murmurs. 
Integumentary System 
- Skin warm, dry; Nail beds pink without clubbing.  
Labs
| Test | Patient’s Result | Reference |
|---|---|---|
| Glucose (fasting) | 132 | 60-120 mg/dL |
| BUN | 20 | 7-24 mg/dL |
| Creatinine | 0.8 | 0.7-1.4 mg/dL |
| Sodium | 141 | 135-145 mEq/L |
| Sodium | 141 | 135-145 mEq/L |
| Chloride | 97 | 95-105 mEq/L |
| HCO3 | 24 | 22-28 mEq/L |
| A1C | 7.2 | |
| Urinalysis
Protein Glucose Ketones |
Negative Positive Negative |
|
| Oral glucose tolerance test (OGTT) | 220 mg/dL |
J.T. is diagnosed with diabetes. Review all information provided in the case to answer the following questions.
Case Study Questions
Pathophysiology & Clinical Findings of the Disease
- Review the lab findings and decide if the diagnosis is Type 2 or Type 1 Diabetes Mellitus.
- Explain the pathophysiology associated with your chosen diagnosis
- Identify at least three subjective findings from the case which support the chosen diagnosis.
- Identify at least three objective findings from the case which support the chosen diagnosis.
Management of the Disease
*Utilize the required Clinical Practice Guideline (CPG) to support your treatment recommendations.
- Identify two (2) “Evidence A” recommended medication classes for the treatment of this condition and provide an example (drug name) for each.
- Describe the mechanism of action for each of the medication classes identified above.
- Identify two (2) “Evidence A” recommended non-pharmacological treatment options for this patient.
- Utilizes the required Clinical Practice Guideline (CPG) to support the chosen treatment recommendations
| ASSIGNMENT CONTENT | |||
|---|---|---|---|
| Category | Points | % | Description |
| Pathophysiology & Clinical Findings of the Disease | 45 | 45% | The student:
(5 Required Elements) |
| Management of the Disease | 45 | 45% | The student:
(4 Required Elements) |
| 90 | 90% | Total CONTENT Points = 90 pts | |
| ASSIGNMENT FORMAT | |||
| Category | Points | % | Description |
| Organization, spelling, grammar & APA format | 10 | 10% | The student:
|
| 10 | 10% | Total FORMAT Points = 10 pts | |
| 100 | 100% | ASSIGNMENT TOTAL= 100 points | |
Rubric
NR507 Week 6 Diabetes Case Study
| Criteria | Ratings | Pts | |||||
|---|---|---|---|---|---|---|---|
| This criterion is linked to a Learning OutcomePathophysiology & Clinical Findings of the DiseaseThe student: – Identifies the correct type of diabetes – Explains the pathophysiology associated with the chosen disorder. – Supports the pathophysiology statement with at least one appropriate, scholarly reference (textbook is acceptable for pathophysiology statements only). – Identifies at least three subjective findings from the case. – Identifies at least three objective findings from the case. (5 Required Elements) |
|
45 pts | |||||
| This criterion is linked to a Learning OutcomeManagement of the DiseaseThe student:
– Utilizes the required Clinical Practice Guideline (CPG) to support the chosen treatment recommendations. – Identifies two (2) “Evidence A” recommended medication classes for the treatment of the condition and provides an example (drug name) for each. – Identifies two (2) “Evidence A” recommended non-pharmacological treatment options for the condition. – Describes the mechanism of action for each of the medication classes identified above (4 Required Elements) |
|
45 pts | |||||
| This criterion is linked to a Learning OutcomeOrganization, spelling, grammar & APA formatThe student:
– Uses the week 6 case study template for case study responses. – Provides correct in-text citations for responses which match the reference page. – Has minimal spelling, grammar & APA format errors. |
|
10 pts | |||||
| This criterion is linked to a Learning OutcomeLate penalty deductionsStudents are expected to submit assignments by the time they are due. Assignments submitted after the due date and time will receive a deduction of 10% of the total points possible for that assignment for each day the assignment is late. Assignments will be accepted, with penalty as described, up to a maximum of three days late, after which point a zero will be recorded for the assignment. Quizzes and discussions are not considered assignments and are not part of the late assignment policy. |
|
0 pts | |||||
| Total Points: 100 | |||||||
